FAQ

 

1. What is Meaningful Use?
   "Meaningful Use" is defined in three ways in the Bill:
   • Use of a certified product complete with ePrescribing capability as determined appropriate by the Secretary of HHS
   • The EHR technology is connected for the electronic exchange of PHI
   • Complies with submission of reports on clinical quality measures

The final criteria for standards will be determined by the Secretary of Health & Human Services before the utilization incentives begin. Note that the Secretary of HHS shall seek to improve the use of electronic health records and healthcare quality over time by requiring more stringent measures of meaningful use.

2. What types of providers are eligible for the Medicare incentives?
   “Eligible professional” is defined as:
   • doctor of medicine or osteopathy
   • doctor of dental surgery or medicine
   • doctor of podiatric medicine
   • doctor of optometry
   • chiropractor

3. How will the physician payment be calculated under Medicare?
   The Medicare payments will be calculated by multiplying the submitted allowable charges to Medicare by 75%, up to the capped amount for the year. So a physician aiming to collect the full incentive payment of $18,000 in 2011 will need to submit allowable charges of at least $24,000. Conversely, a physician submitting only $16,000 in allowables would collect $12,000 in 2011, even though the cap is higher.

4. What if a physician does not demonstrate use of an EHR after the incentives are in place?
   A physician who did not demonstrate meaningful use in 2014 will have their Medicare fee schedule reduced beginning in 2015. Reductions will be:
   • For 2015, down to 99 percent of the regular fee schedule
   • For 2016, down to 98 percent
   • For 2017 and each subsequent year, down to 97 percent

   If the Secretary finds that less than 75% of eligible healthcare professionals are utilizing EHR beginning in 2018, the Secretary can further reduce the fee schedule to 96% and then 95% in subsequent years but not further.

5. Is this a loan? Will this money have to be paid back if you receive the help for EHR?
   With the exception of loan programs which will be established by the States in 2010 based on Stimulus funding from the Federal government, the incentive payments and funding sources identified as “grants” will not be loans or expected to be repaid at any point.

6. What are the different incentive options?
   There are two incentive payment programs outlined under the HITECH Act – one through Medicare and another from Medicaid. Providers can only submit for payment of an incentive bonus from one of the programs so will need to analyze their organization’s public payer mix to determine where they stand to benefit most. Both require that a provider prove “meaningful use” of an EHR product to qualify for the incentives, as well.

7. What are the bonus payments that will be available to physicians under Medicare?
   Under Medicare, physicians will be eligible for up to the following as soon as they can demonstrate "meaningful use" (beginning in 2011):
   
   
   

8. Who is eligible for Medicaid incentive payments?
   A healthcare provider is eligible for incentive payments from Medicaid who:
   • Is not hospital-based and has at least 30 percent of the professional’s patient volume coming from Medicaid patients
   • Is a pediatrician, who is not hospital-based and who has at least 20 percent of the patient volume coming from Medicaid patients
   • Practices predominantly in a FQHC or rural health clinic and has at least 30 percent of the professional’s patient volume coming from Medicaid patients
   • Is a children’s hospital, or an acute-care hospital that is not described in clause and that has at least 10 percent of the hospital’s patient volume coming from Medicaid patients
   • Incentive payments will be based on a calculation that factors the physician’s Medicaid mix in combination with up to $25,000 the first year and $10,000 each subsequent year for five years.

9. Will our clinicians be more productive?
   Initially, the learning curve for use of EHR is expected to be fairly steep. When clinicians first begin using EHR for order entry and note authoring, it will take them longer to see patients. The decrease may be as much as thirty percent at first, and facilities must be prepared for this. However, times saved by direct entry of orders and by not having to search for information will soon begin to reverse the productivity impact. This impact can be reduced further if the facility provides adequate support and training for providers. Eventually, providers will be able to document both more thoroughly and more rapidly on standardized documentation templates than previously possible by handwriting

10. What kind of technical equipment do we need to run EHR?
    The basic consideration in answering the equipment question is that every staff member who needs to read or add to the medical record needs access to it. This means that they must have a Windows computer available wherever and whenever they need to see the record. For the most part this will mean computer access in every examination room, at every provider's desk, at all nursing work areas, and at all other points of patient care or consultation. This might be accomplished by fixed desktop computers or by mobile workstations.
    Since these computers will have to retrieve patient data, the facility needs to have a reliable network. This network should also have a high-speed Internet connection, to facilitate the clinical decision support functions of EHR.

11. What do we do when the system crashes?
    Certainly, every effort must be made to avoid system down time, but it could happen. Hardware crashes due to power outages and equipment failure are more common than software crashes, and these risks are mitigated by the use of isolated power systems and redundant servers.
    This is why partnering with an IT company that has experience in assisting medical practices adopt EHR is critical. A Continuity of Operations Plan in place to deal with these events is essential to continuing patient care when this happens.

12. How long will it take our facility to implement EHR?
    EHR implementation is not a fast process, but the actual amount of time it will take a facility to implement EHR depends on a variety of factors including:
    • Size of facility
    • Services offered (e.g. Pharmacy, Lab, Radiology)
    • Amount of administrative support
    • Amount of staff time dedicated to EHR implementation

A good estimate for most facilities is that it takes approximately 9-18 months from the time the decision is made to implement EHR until the first provider is documenting all aspects of a patient visit in the EHR.

13. What's wrong with paper records?
    Here are a few issues with paper records, and anyone who works with them could think of more:
    • Only one person can have the chart at a time
    • Keeping track of chart location is difficult
    • Delays in retrieving charts are common and aggravating
    • Handwriting is often illegible
    • Charts may be disorganized, with information hard to find
    • Some information doesn't get into the chart for many days
    • There aren't enough tabs for all the different types of forms
    • Many trees are sacrificed to print encounter forms and health summaries for each visit
    • Charts get very fat
    • Metal tabs break, and the charts fall apart
    • New volumes don't contain important old information
    • Back injuries from lifting charts have resulted in worker compensation claims
    • Paper charts that are left sitting around can easily be browsed by unauthorized people
    • Charts may be stolen or tampered with
    • Paper filing is time consuming and labor intensive
    • Chart files take up a lot of valuable space
    • Charts have to be retired just to save space